Provider Demographics
NPI:1740005644
Name:AHMED, ALI MOHAMED
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:MOHAMED
Last Name:AHMED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 22ND AVE S UNIT 316
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-5010
Mailing Address - Country:US
Mailing Address - Phone:612-200-6720
Mailing Address - Fax:
Practice Address - Street 1:3029 22ND AVE S UNIT 316
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-5010
Practice Address - Country:US
Practice Address - Phone:612-200-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1496192700023172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker